Eating Disorder Treatment

Deciding what level of care you need or your loved one needs can be daunting. Today I will give an overview of the five levels of care that are available for eating disorder treatment and describe the type of person who would be a good fit for each level. If you’re still not sure which is right for you, please reach out to us so we can talk about it.

When deciding what level of care is needed, several factors should be considered. Historically, weight was the main determinant, but thankfully, we are slowly moving away from that approach. Now, most treatment providers and insurance companies take into account your overall physical condition, psychology, eating disorder behaviors, and other factors. The American Psychological Association (APA) provides suggested criteria for each level of eating disorder treatment. These criteria include:

• Medical status
• Suicidality
• Weight (as a percentage of healthy body weight)
• Motivation to recover, including cooperativeness, insight, and ability to control obsessive thoughts
• Co-occurring disorders, including substance use, depression, and anxiety
• Structure is needed for eating and gaining weight
• Ability to control compulsive exercising

Let’s take a look a the levels of eating disorder treatment and how the APA’s guidelines apply to each of them.

Level One: Outpatient: Outpatient treatment includes individual sessions with a therapist and/or dietitian, typically once or twice a week. Outpatient treatment typically last for months to years, and can sometimes include periods of being in a higher level of care. Also, sometimes outpatient care can include group therapy. Outpatient eating disorder treatment is likely right for you if you:

• are medically stable
• have at least some motivation for recovery
• can implement some structure on your own regarding meals
• are able to at times limit your eating disorder behaviors, including compulsive exercise
• are not suicidal with a plan or intent to harm yourself

Level Two: Intensive Outpatient Programs (IOP): IOPs usually include about three hours of programming for at least two to three days a week. At this level of care, you would live at home and could probably still work or go to school. Usually, one meal or snack takes place at the treatment center. IOP eating disorder treatment is likely right for you if you:

• are medically stable
• have at least some motivation for recovery
• can implement some structure on your own regarding meals but need a bit of support/accountability
• are able to at times limit your eating disorder behaviors, including compulsive exercise, but need a bit of support/accountability
• are not suicidal with a plan or intent to harm yourself

Level Three: Partial Hospitalization (aka Day Programs): Partial hospitalization (PHP) is typically treatment during the day, while letting you still go home at night. PHP is usually 6 to 11 hours a day for at least five days a week, so the majority of meals are at the treatment center. PHP eating disorder treatment is likely right for you if you:

• are medically stable
• have some motivation for recovery but are struggling to feel motivated at times
• need structure and support for most meals 
• struggle to limit your eating disorder behaviors, including compulsive exercise and need quite a bit of support/accountability
• are not suicidal with a plan or intent to harm yourself

Level Four: Residential Treatment: Residential treatment provides 24-hour care for those who are medically stable but still require round-the-clock supervision meals and behaviors. Residential treatment is typically 6 weeks or longer. This level of care is likely right for you if you are medically stable and have a/an:

• need for supervision to eat 
• need for supervision to not purge or use other behaviors
• inability to stop exercising
• lack of treatment options near home

Level Five: Inpatient Treatment: Inpatient treatment is 24-hour care in a medical hospital. This level is for individuals who are not medically stable and need round-the-clock medical assistance or monitoring (including intravenous fluids, tube feeds, and constant monitoring of vital signs). This is often a necessary level of care for individuals who do not cooperate with treatment protocols at lower levels of care. Inpatient stays can last days to weeks. This is likely the right level for you if you are not medically stable or if you have:

• unstable heart rate or blood pressure
• significant weight decline and/or food refusal
• evidence of malnutrition
• other psychiatric disorders that would require hospitalization
• suicidal thoughts with intent to harm yourself

A quick note in case you’re asking yourself Am I Really Sick Enough for Treatment?…

I hear this question all the time. Sweet friend, the answer is always “YES!”

Your eating disorder will try to convince you that you don’t need or don’t deserve help. It will whisper lies about things not being that bad, about you being able to handle it, about not looking like you even have an eating disorder…

Don’t listen to any of that or any other excuse your ED gives you. Eating disorders don’t have a “look” despite the stereotype, and people at all weighs can have an ED. And you don’t have to be at the point of needing hospitalization to be “sick enough”. Please, please don’t wait for that point to get help.

You could miss out on spending years of your life with joy and purpose instead of spending them still consumed with your ED. You could do irreparable damage to your body, or yes, even die.

Don’t believe your eating disorder. You are worthy of help and support. Today. Not sometime in the future when things get worse. TODAY.

xo.

Final Thoughts…

Again, I know it might feel overwhelming trying to figure out the right eating disorder treatment for you (or your loved one). If you’re still not sure which is right or if you need a referral to higher level of care, please reach out to us. If you’re ready to start outpatient therapy, it’s easy: schedule an appointment online.

Sources
https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/level-care-guidelines-patients